System and method for delivering a target volume of fluid

ABSTRACT

A method for delivering a target volume of fluid to a destination is provided. The method includes delivering a first volume of fluid to the destination in increments each having approximately a first incremental volume, the first volume of fluid being less than the target volume and delivering a second volume of fluid to the destination in increments each having approximately a second incremental volume, the second incremental volume being less than the first incremental volume, such that the sum of the first volume and the second volume is approximately equal to the target volume.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a division of U.S. application Ser. No. 14/297,183filed Jun. 5, 2014 and issued on Jul. 25, 2017 as U.S. Pat. No.9,713,667, which is a continuation of U.S. application Ser. No.11/926,700 filed Oct. 29, 2007 and issued on Sep. 2, 2014 as U.S. Pat.No. 8,821,475, which is a divisional of U.S. application Ser. No.10/412,658 filed on Apr. 10, 2003, now issued as U.S. Pat. No. 7,544,179on Jun. 9, 2009, which claims priority from U.S. Provisional ApplicationSer. No. 60/371,894 filed on Apr. 11, 2002, all of which are herebyincorporated herein by reference.

TECHNICAL FIELD AND BACKGROUND ART

The present invention relates to fluid delivery systems, and inparticular to systems and methods for accurately delivering a targetvolume of fluid to a destination.

Such systems regulate the rate of flow of fluid through a line. Someexamples of fluid delivery systems are peritoneal dialysis machines andintravenous fluid delivery systems. These systems may include apermanent housing which does not come into direct contact with thetransporting fluid and into which a fluid-exposed disposable cassette isplaced. The disposable cassette includes flexible membranes, or otherstructures that respond to pressure and that separate the permanentcomponents from the fluid being delivered. Examples of such fluiddelivery systems and their sub-components (e.g., pressure conductionchambers, flow measurement systems and valves) are disclosed in U.S.Pat. Nos. 4,778,451, 4,826,482, 4,976,162, 5,088,515, 5,178,182 issuedto Kamen, U.S. Pat. No. 5,989,423 issued to Kamen et al. and U.S. Pat.No. 6,503,062 issued to Gray et al. These patents are all herebyincorporated herein by reference.

One problem with respect to fluid delivery systems, such as inperitoneal dialysis, arises when treating subjects with low fill volumecapacities, such as a child. For example, in peritoneal dialysissystems, a fill volume of 1000 mL or less generally indicates a low fillvolume while fill volumes of greater than 1000 mL are typical for anaverage adult's fill volume. Thus, a single fluid delivery system maynot be appropriate for treating both an average adult and a child.

Another problem arises with respect to fluid delivery systems when twoor more fluids from two or more sources must be delivered to a subjector patient simultaneously and in a particular ratio. It is difficult tomaintain a consistent ratio of the different fluids for simultaneousdelivery to the subject because each source may deliver its solution tothe system at different rates and/or in different volumes. Consequently,it is difficult to maintain a consistent ratio of the different fluidsin the fluid delivery system at any one time.

SUMMARY OF THE INVENTION

In a first embodiment of the invention, a method for delivering a targetvolume of fluid to a destination includes delivering a first volume offluid to the destination in increments each having approximately a firstincremental volume, the first volume of fluid being less than the targetvolume. A second volume of fluid is then delivered to the destination inincrements each having approximately a second incremental volume. Thesecond incremental volume is less than the first incremental volume, andthe sum of the first volume and the second volume is approximately equalto the target volume.

Delivering the first and second volumes of fluid to a destination mayinclude delivering the first and second volumes of fluid parenterally toa human subject. Similarly, delivering the first and second volumes offluid to a destination may include delivering the first and secondvolumes of fluid to a fluid reservoir and/or delivering the first andsecond volumes of fluid to a container. Such a container may be aheating bag, such as may be used in conjunction with a peritonealdialysis system, and/or a pump chamber. In accordance with a relatedembodiment, the first volume may be approximately equal to the targetvolume minus a finish volume and the second incremental volume may beless than the finish volume. In a related embodiment, the secondincremental volume may be less than one third the finish volume.

In accordance with another embodiment of the invention, a system fordelivering a target volume of fluid to a destination includes a fluidcontrol module for delivering a first volume of fluid to the destinationin increments each having approximately a first incremental volume, thefirst volume of fluid being less than the target volume. The fluidcontrol module also delivers a second volume of fluid to the destinationin increments each having approximately a second incremental volume, thesecond incremental volume being less than the first incremental volume.The sum of the first volume and the second volume is approximately equalto the target volume. The system also includes a valve arrangement forcontrolling fluid communication to the destination and a controller fordetermining the volume of fluid delivered to the destination and forcontrolling the valve arrangement and the fluid control module. Thefluid control module may deliver the first and second volumes of fluidto a human subject and the first and second volumes of fluid may bedelivered parenterally. Similarly, the fluid control module may deliverthe first and second volumes of fluid to a fluid reservoir and/or acontainer such as a heating bag and/or a pump chamber.

In accordance with related embodiments, the first volume may beapproximately equal to the target volume minus a finish volume and thesecond incremental volume may be less than the finish volume. Forexample, the second incremental volume may be less than one third thefinish volume.

In accordance with a further embodiment of the invention, a method forsimultaneously delivering a target volume of fluid from two sources in adesired ratio to a common destination includes delivering a first volumeof fluid from a first source and a second volume of fluid from a secondsource to the destination in increments each having approximately afirst incremental volume, the first incremental volume of fluid beingsubstantially less than the target volume. After delivery of a firstincremental volume of fluid from the first source and the second source,the volume of fluid delivered to the destination from the first sourceand the volume of fluid delivered to the destination from the secondsource is measured. Delivery of the first volume of fluid to thedestination is suspended when the first volume exceeds the second volumeby a fraction, which may be a predetermined fraction, of the firstincremental volume. A first incremental volume of fluid from the secondsource is delivered to the destination, and delivery of the first volumeof fluid to the destination is resumed.

In accordance with related embodiments, the first incremental volume offluid may be less than one quarter of the target volume. In accordancewith further related embodiments, the desired ratio may be 1:1 and thepredetermined fraction may be one half. Delivering the first and secondvolumes of fluid to a destination may include delivering the first andsecond volumes of fluid parenterally to a human subject. Similarly,delivering the first volume and second volumes of fluid to a destinationmay include delivering the first and second volumes of fluid to a fluidreservoir and/or container, and such a container may be a heating bagand/or a pump chamber.

In accordance with other related embodiments, the method may includedetermining that approximately the target volume of fluid has beendelivered to the destination and measuring the volume of fluid deliveredto the destination from the first source and the volume of fluiddelivered to the destination from the second source. A third volume offluid from the source that has delivered a smaller volume of fluid tothe destination may then be delivered in increments each havingapproximately a second incremental volume, the second incremental volumebeing less than the first incremental volume, such that the volume offluid delivered to the destination from the first source and the volumeof fluid delivered from the second source are in approximately thedesired ratio. The sum of the first volume and the second volume may beapproximately equal to the target volume minus a finish volume, and thesecond incremental volume may be less than the finish volume. In onerelated embodiment, the second incremental volume is less than one thirdthe finish volume.

In accordance with another embodiment of the invention, a system forsimultaneously delivering a target volume of fluid from two sources in adesired ratio to a common destination includes a first fluid source, asecond fluid source, and a fluid control module. The fluid controlmodule delivers a first volume of fluid from the first fluid source anda second volume of fluid from the second fluid source to the destinationin increments each having approximately a first incremental volume, thefirst incremental volume being substantially less than the targetvolume. The fluid control module also measures the volume of fluiddelivered to the destination from the first source and the volume offluid delivered to the destination from the second source, suspendsdelivery of the first volume of fluid to the destination when the firstvolume exceeds the second volume by a fraction, which may be apredetermined fraction, of the first incremental volume, and resumesdelivery of the first volume of fluid to the destination. The systemalso includes a valve arrangement for controlling fluid communicationbetween the destination and first and second fluid sources and acontroller for determining the first and second volumes of fluid, thefirst incremental volume of fluid, and for controlling the valvearrangement and the fluid control module.

In accordance with related embodiments, the first incremental volume maybe less than one quarter of the target volume. Additionally, the desiredratio may be 1:1 and the predetermined fraction may be approximately onehalf. In accordance with yet further related embodiments, the fluidcontrol module may deliver the first and second volumes of fluid to ahuman subject, and the fluid control module may deliver the first andsecond volumes of fluid parenterally. Similarly, the fluid controlmodule may deliver the first and second volumes of fluid to a fluidreservoir and/or to a container. Such a container may be a heating bagand/or a pump chamber. The controller may also determine thatapproximately the target volume minus a finish volume of fluid has beendelivered to the destination. Further, the fluid control module maymeasure the volume of fluid delivered to the destination from the firstsource and the volume of fluid delivered to the destination from thesecond source and deliver a third volume of fluid from the source thathas delivered a smaller volume of fluid to the destination. The thirdvolume of fluid may be delivered in increments each having approximatelya second incremental volume. The second incremental volume may be lessthan the first incremental volume, such that the volume of fluiddelivered to the destination from the first source and the volume offluid delivered from the second source are in approximately the desiredratio. Further, the sum of the first and the second volumes may beapproximately equal to the target volume minus a finish volume and thesecond incremental volume may be less than the finish volume. Forexample, the second incremental volume may be less than one third thefinish volume.

In accordance with a further embodiment of the invention, a system fordelivering a target volume of fluid to a destination includes fluiddelivery means for delivering a first volume of fluid to the destinationin one or more first incremental volumes, the first volume of fluidbeing less than the target volume, and delivering a second volume offluid to the destination in one or more second incremental volumes, thesecond incremental volume being less than the first incremental volume.The system also includes measuring means for measuring the volume offluid delivered to the destination and control means for controlling thefluid delivery means.

In accordance with another embodiment of the invention, a system forsimultaneously delivering a target volume of fluid from two sources in adesired ratio to a common destination includes a first fluid source anda second fluid source. Fluid delivery means delivers a first volume offluid from the first fluid source and a second volume of fluid from thesecond fluid source to the destination in one or more first incrementalvolumes, the first incremental volume being substantially less than thetarget volume. Measuring means measures the volume of fluid delivered tothe destination from the first source and the volume of fluid deliveredto the destination from the second source. Control means suspendsdelivery of the first volume of fluid to the destination when the firstvolume exceeds the desired ratio with respect to the second volume by afraction, which may be a predetermined fraction, of the firstincremental volume and then resumes delivery of the first volume offluid to the destination.

In accordance with a further embodiment of the invention, a system forsimultaneously delivering a target volume of fluid from two sources in adesired ratio to a common destination includes a first fluid source anda second fluid source. The system also includes fluid delivery means fordelivering a first volume of fluid from the first fluid source and asecond volume of fluid from the second fluid source to the destinationin one or more first incremental volumes, the first incremental volumebeing substantially less than the target volume, and measuring means formeasuring the volume of fluid delivered to the destination from thefirst source and the volume of fluid delivered to the destination fromthe second source. The control means suspends delivery of the firstvolume of fluid to the destination when the first volume exceeds thesecond volume by a fraction, which may be a predetermined fraction, ofthe first incremental volume and resumes delivery of the first volume offluid to the destination. In accordance with related embodiments, thedesired ratio may be 1:1 and the predetermined fraction may beapproximately one half.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing features of the invention will be more readily understoodby reference to the following detailed description, taken with referenceto the accompanying drawings, in which:

FIG. 1 is a perspective view of an automated fluid delivery system thatmay be used in conjunction with the present invention;

FIG. 2 is a flow chart illustrating a method for delivering a targetvolume of fluid to a destination in accordance with an embodiment of theinvention;

FIG. 3 is a flow chart illustrating a method for simultaneouslydelivering a target volume of fluid from two sources in a desired ratioto a common destination in accordance with another embodiment of theinvention;

FIG. 4 is a flow chart illustrating a method for simultaneouslydelivering a target volume of fluid from two sources in a desired ratioto a common destination in accordance with yet another embodiment of theinvention; and

FIG. 5 is a block diagram illustrating one example of a system foremploying the methods of FIGS. 3 and 4.

FIGS. 6A and 6B show two types of valves that can be used in the presentinvention.

FIG. 7 shows cross-sectional views of a disposable cartridge, orcassette, that can be used in the present invention.

DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS

FIG. 1 is a perspective view of an automated fluid management systemthat may be used in conjunction with the present invention. The system100 includes a liquid supply and delivery set 102, a fluid controlmodule 104 that interacts with the delivery set 102 to pump liquidthrough it, and a controller 106 that governs the interaction to performa selected procedure. In the depicted embodiment, the fluid controlmodule and controller are located within a common housing 182.

The fluid control module 104 utilizes a pneumatic pumping action toemulate gravity flow, regardless of the position of the source solutionbags 184. The pumping action may be the result of pressurizing one ormore fluid chambers through use of a control gas or liquid, or othermethods known in the art, such as pumps, pistons, piezo-electricmechanisms, pressurized reservoirs, valves, clamps and vents. As notedabove, these pressurizing devices are explained in greater detail in thepatents referenced above and incorporated herein by reference.

The controller 106 carries out process control and monitoring functionsfor the fluid control module 104. The controller includes a userinterface 167 with a display screen 137 and control pad. The interface167 presents menus, sub-menus and status information to the user duringa therapy session. The interface 167 also allows the user to enter andedit therapy parameters, and to issue therapy commands. In oneembodiment, the user interface 167 receives characters from a keypad,displays text to the display screen 137 and sounds an alarm whenappropriate. The control pad may include a “Go” key 135, which whenpressed causes the interface 167 to display a main menu on the displayscreen 137 for initiating a therapy session, and a “Stop” key 139 whichwhen pressed causes a therapy session to cease. The interface 167 mayalso include keys 133 for traversing through the information and menusdisplayed on the display screen 137 and an “Enter” key 134 for causingdata to be input to the system or for selecting an entry from the menus.

In the illustrated embodiment, the controller 106 comprises a centralprocessing unit. The central processing unit may employ conventionalreal time multi-tasking to allocate tasks. The central processing unitmay itself be programmable or alternatively, it may run under thedirection of a software, middle-ware or hardware program external to thesystem.

In use, for example as a peritoneal dialysis system, the user connectsthe set 102 to his/her indwelling peritoneal catheter 108. The user alsoconnects the set 102 to individual bags 184 containing peritonealdialysis solution for infusion. The set 102 also connects to a heatingbag 180 in which the dialysis solution is heated to a desiredtemperature. In accordance with an embodiment of the invention describedin more detail below, two or more fluids from different sources may besimultaneously pumped to the heating bag in a desired ratio.

The controller 106 paces the fluid control module 104 through aprescribed series of fill, dwell, and drain phases typical of anautomated peritoneal dialysis procedure. During the fill phase, thefluid control module 104 infuses the heated solution through the set 102and into the patient's peritoneal cavity. Following the dwell phase, thefluid control module 104 institutes a drain phase, during which thefluid control module 104 discharges spent dialysis solution from thepatient's peritoneal cavity through the set into a nearby drain.

The delivery set 102 includes a cassette (not visible) which mountsinside a holder in the fluid control module 104. The cassette serves inassociation with the fluid control module 104 and the controller todirect liquid flow among multiple fluid sources and destinations that anautomatic peritoneal dialysis procedure requires. The cassette forms anarray of interior cavities in the shapes of wells and channels. Theinterior cavities create one or more pump chambers and one or more pathsto convey fluid. The interior cavities also create one or more valvestations to interconnect the fluid paths with the pump chambers and witheach other. The number and arrangement of pump chambers, liquid pathsand valve stations can vary. Such a cassette is described in U.S. Pat.Nos. 5,989,423 and 5,178,182 both of which, as noted above, areincorporated herein by reference.

A special valve system has been designed for use with the disposablecartridge embodiment above. Specifically, this valve system can be usedfor valves A and B in the above embodiments, since these valves come incontact with intravenous fluid and therefore should be part of thedisposable cartridge. The valve system is characterized by the use of asecond control fluid, such as air. (The control fluid can be differentthan the measurement gas, but preferably both are air.) This controlfluid urges a flexible membrane against a receiving surface such that aseal is formed and the line is closed off. The fluid line, flexiblemembrane, and receiving surface are arranged in such a mechanicallyadvantageous manner that relatively little fluid pressure in the controlline is required to close off fluid under relatively high pressure inthe main line.

One simple embodiment of the present invention is shown in FIG. 6A,wherein a single valve is provided. The fluid line input 61 and output62 are mounted to a fluid tight valving chamber 63. It is contemplatedthat this valving chamber 63 be made of a rigid material, such as moldedhard plastic. The valving chamber includes fittings for the input andoutput lines. The valving chamber further includes a mouth 64 connectedto the fluid input 61, which in the present embodiment displays abeveled contour to facilitate efficient sealing. However, it would alsobe possible within the spirit of the invention to have a mouth 64 thatis flush with the wall of the chamber.

One wall of the valving chamber is provided with a flexible impermeablemembrane 65, which is in communication with a control fluid supply line66. The membrane 65 is mounted with relation to the control fluid supplyline 66 and the mouth 64 such that when control fluid pressure isincreased in the control fluid supply line 66, the flexible membrane 65is urged against the mouth 64. A material is chosen for the membrane 65such that the membrane “grips” the mouth 64, thereby enhancing the seal.When it is desired to open the fluid line, control fluid pressure isdiminished until main line fluid pressure sufficient to push themembrane 65 away from the mouth, thus break the seal.

FIG. 7 shows one embodiment of a disposable housing unit (or “cartridge”or “cassette”). This particular unit has two concave indentations 71 forthe container portion of the disposable, so that two fluid controlsystems can function in parallel. In a preferred embodiment, two fluidcontrol systems are used to deliver intravenous fluid to a patient inorder to make the flow of fluid smoother. As one container 71 isdispensing, the other is filling. Thus, fluid is delivered in moreclosely spaced and smaller pulses, rather than larger pulses that comeless frequently and that have longer periods between them.

The disposable cartridge shown in FIG. 7 also has ten valves 72 of thetype depicted in FIG. 6A, with the input 61 and the output 62 showing.This side of the unit has a membrane stretched across and attached to itthat serves as the membrane (65 in FIG. 6A) for the valves 72 and themembrane for the container 71.

In order to accommodate patients with small abdominal cavities, a newprocess and system is presented that limits the available fill volume. Aclinician will be able to select a “low fill mode” from among the modesavailable on the fluid delivery system. For example, when the low fillmode is on, the fill volumes available will be limited to a range of60-1000 mL.

Since the fill volumes for the low-fill mode may be as small as 60 mL,it is necessary to achieve a high level of targeting accuracy for theseapplications. An acceptable range of accuracy may be, for example, +5mL/−10 mL. It may also be desirable that conforming to this accuracyspecification does not take substantially longer than a standard fill.

The targeting accuracy is improved by executing a more intermittent fillduring the last phase, in which the incoming flow is stopped one or moretimes to perform a volume measurement and assess progress. The nominaloperation of this fill routine does not result in fills thatconsistently stop at the low end of the tolerance; instead the nominaloperation should fill to the mid-point of the tolerance range. This fillroutine especially improves performance for low-fill applications.

FIG. 2 illustrates a method (i.e., a fill routine) for delivering atarget volume of fluid to a destination in accordance with oneembodiment of the invention. Such a destination may be a human subject,the heating bag 180, a reservoir, a fluid container or pump chamber asillustrated with respect to FIG. 5. The fluid may further be deliveredto the human subject parenterally. The method includes delivering 201 afirst volume of fluid to the destination in increments each havingapproximately a first incremental volume. The first volume of fluid isless than the target volume by an amount at least as large as the firstincremental volume. For example, if the target volume is 500 mL, thefirst incremental volume may be 10 to 50 mL. A second volume of fluid isthen delivered 202 to the destination in increments each havingapproximately a second incremental volume. The second incremental volumeis less than the first incremental volume, and the sum of the firstvolume and the second volume is approximately equal to the targetvolume. For example, if the first incremental volume is 15 mL, then thesecond incremental volume may be 1 to 3 mL. Note that a plurality offirst incremental volumes may be delivered before delivering the secondvolume. Thus, to achieve a target volume of 500 mL, the first volume maybe approximately 485 mL, delivered in thirty or more first incrementalvolumes of approximately 15 mL each, before the second volume of fluidis delivered in the second incremental volumes of approximately 1 to 3mL each. Thus, the first volume may approximately equal the targetvolume minus a finish volume (i.e., the second volumes) and the secondincremental volume may be less than the finish volume. For example, thesecond incremental volume may be one third the finish volume

FIG. 3 is a flow chart illustrating a method for simultaneouslydelivering a target volume of fluid from two sources in a desired ratio,in this case in a 1:1 ratio, to a common destination. Again, such adestination may be a human subject, the heating bag 180, a reservoir, afluid container or pump chamber. Further, the fluid may be delivered toa human subject parenterally. In a first step, a first volume of fluidfrom a first source and a second volume of fluid from second source isdelivered 301 to the destination in increments each having approximatelya first incremental volume. The first volume may be measured in one ormore of the pump chambers discussed above in connection with the fluiddelivery system of FIG. 1 and in connection with the system FIG. 5. Inone embodiment, for example, the volume measurement systems of U.S. Pat.Nos. 4,976,162 and 4,826,482 (incorporated herein above) are employed.The first incremental volume of fluid is substantially less than thetarget volume. In one embodiment, the first incremental volume is lessthan one quarter of the target volume. However, the first incrementalvolume may be less than the target volume by any desired fraction, suchas one eighth, one third, one half, two thirds, etc.

After delivery of a first incremental volume of fluid from each of thefirst source and the second source, the volume of fluid delivered to thedestination from the first source and the volume of fluid delivered tothe destination from the second source is measured 302. Such deliverymay occur simultaneously and such measurements may be performed by thecontroller 106 by using pressure transducers contained in the fluidcontrol module 104 or other fluid volume measuring apparatuses. Deliveryof the first volume of fluid to the destination is suspended 303 whenthe first volume exceeds the second volume by a fraction, which may be apredetermined fraction, of the first incremental volume. For example,delivery of the first volume of fluid to the destination may besuspended when the first volume exceeds the second volume byapproximately one half of the first incremental volume in order toattain a 1:1 one ratio. A first incremental volume of fluid is thendelivered 304 to the destination from the second source, and delivery ofthe first volume of fluid to the destination is resumed 305. It will beappreciated that this process may be adapted for a desired ratio otherthan one-to-one. In such a case, the fluids from different sources maybe delivered by incremental volumes that are the same or that aredifferent from each other. It will also be appreciated that this processmay be adapted for use with fluids from more than two different sources.

FIG. 4 is a flow chart illustrating a method for simultaneouslydelivering a target volume of fluid from two sources in a desired (suchas a one-to-one) ratio to a common destination in accordance with yetanother embodiment of the invention. The procedure begins in a mannersimilar to that shown with respect to the embodiment of FIG. 3. That is,a first volume of fluid from a first source and a second volume of fluidfrom second source is delivered 401 to the destination in incrementseach having approximately a first incremental volume. The firstincremental volume of fluid is less than the target volume. In this casethe first incremental volume is less than one quarter of the targetvolume. However, as noted above the first incremental volume may be lessthan the target volume by any desired ratio. After delivery of a firstincremental volume of fluid from each of the first source and the secondsource, the volume of fluid delivered to the destination from the firstsource and the volume of fluid delivered to the destination from thesecond source is measured 402. Again, such measurements may be performedby the controller 106 by using pressure transducers contained in thefluid control module 104 or other fluid volume measuring means. Deliveryof the first volume of fluid to the destination is suspended 403 whenthe first volume exceeds the second volume by a fraction, which may be apredetermined fraction, of the first incremental volume, in this case byone half the first incremental volume. A first incremental volume offluid is then delivered 404 to the destination from the second source,and delivery of the first volume of fluid to the destination is resumed405.

In order to assure that the target volume is delivered in the desiredratio, a determination is made 406 when approximately the target volumeof fluid has been delivered to the destination. The volume of fluiddelivered to the destination from the first source and the volume offluid delivered to the destination from the second source are thenmeasured 407. Following this measurement, a third volume of fluid fromthe source that has delivered a smaller volume of fluid to thedestination is delivered 408 in increments each having approximately asecond incremental volume. The second incremental volume is less thanthe first incremental volume. As a result of delivering the third volumeof fluid, the sum of the volume of fluid delivered to the destinationfrom the first source and the volume of fluid delivered from the secondsource are in approximately the desired ratio, in this case a one to oneratio. The first volume and the second volume may each be approximatelyequal to the target volume minus a finish volume. Similarly, the secondincremental volume may be less than the finish volume by any desiredfraction. For example, in this embodiment, the second incremental volumemay be one third the finish volume.

A system similar to the one described with respect to FIG. 1 mayincorporate the processes described above. In this case the fluidcontrol module 104 or other fluid delivery means such as those disclosedin the patents incorporated above, delivers a first volume of fluid tothe destination in increments each having approximately a firstincremental volume, the first volume of fluid being less than the targetvolume. The fluid control module 104 will also deliver a second volumeof fluid to the destination in increments each having approximately asecond incremental volume. Here again, the second incremental volume isless than the first incremental volume, such that the sum of the firstvolume and the second volume is approximately equal to the targetvolume. The system additionally includes a valve arrangement, showngenerally at 105 for controlling fluid communication between the fluidsource or sources and the destination as well as a controller, such ascontroller 106 or other control means such as a microprocessor orcomputer. The controller 106 determines the volume of fluid delivered tothe destination and for controls the valve arrangement 105 and the fluidcontrol module 104. The controller 106 may also determine whenapproximately the target volume minus a finish volume of fluid hasdelivered to the destination. In addition, the fluid control module 104may measure the volume of fluid delivered to the destination from thefirst source and the volume of fluid delivered to the destination fromthe second source. The fluid control module 104 may then deliver a thirdvolume of fluid from the source that has delivered a smaller volume offluid to the destination in increments each having approximately asecond incremental volume.

FIG. 5 is a block diagram illustrating an example of a system foremploying the methods of FIGS. 3 and 4 above. The system includes afirst fluid source 501 and a second fluid source 502. The first fluidsource 501 is in fluid communication with a first pump chamber 507 viavalve 503 and the second fluid source 502 is in fluid communication witha second pump chamber 510 via valve 505. Pump chamber 507 is also incommunication with a volume measurement system 508 and pump chamber 510is in communication with volume measurement system 509. Alternatively,each pump chamber 507 and 510 may be in communication with a commonvolume measurement system. Each of the pump chambers 507 and 510 mayinclude flexible membranes as described in the above referenced andincorporated patents. Similarly, each of the volume measurement systems508 and 509 may include pressure transducers and positive and/ornegative pressure reservoirs as are also described in the aforementionedincorporated patents. Each of the pump chambers 507 and 510 is in fluidcommunication with a destination 511 via valves 504 and 506respectively. As noted above, the destination 511 may be a humansubject, a reservoir, a container, such as a heating bag, or another,perhaps larger, pump chamber.

In accordance with one embodiment, the goal is to separately track thevolumes moved from each fluid source 501 and 502 and to ensure that thedifference between the fluid delivered from each of the two fluidsources never varies by more than half the volume of a pump chamber.This is achieved by performing in-phase pumping such that both pumpchambers 507 and 510 fill and deliver in sync. For example, if each pumpchamber holds 15 mL, and it is determined that one pump chamber, forexample pump chamber 507, has delivered at least 7.5 mL more fluid tothe destination 511 than the other pump chamber 510, then fluid deliveryfrom pump chamber 507 will be suspended while pump chamber 510 performsa catch-up stroke. Such a determination is made by measuring the fluidvolumes of each pump chamber 507 and 510 for each pumping stroke viavolume measurement systems 508 and 509 respectively. (It should be notedthat while each pump chamber 507 and 510 may have a capacity of 15 mL,somewhat less than 15 mL of fluid may be delivered to and by each pumpchamber during any single pumping stroke.)

When the target volume (the volume of fluid intended to be delivered tothe destination) has been delivered to the destination 511, the pumpchamber, perhaps pump chamber 510, that has delivered the most fluid tothe destination 511 will stop pumping. The pump chamber which hasdelivered the least amount of fluid, in this case pump chamber 507, willthen switch to a “targeting mode” in which a maximum of 3 mL of fluid isdelivered to the destination 511 per pump chamber stroke. This targetingmode insures that a 1:1 ratio (or other desired ratio) between fluiddelivered to the destination 511 from the first fluid source 501 andfluid delivered to the destination 511 from the second fluid source 502is achieved to within approximately plus 2 mL or minus 1 mL.

While the invention has been described in connection with specificembodiments thereof, it will be understood that it is capable of furthermodification. This application is intended to cover any variation, uses,or adaptations of the invention and including such departures from thepresent disclosure as come within known or customary practice in the artto which the invention pertains.

What is claimed is:
 1. A method for operating a fluid control module ofa pumping system using a controller to operate a pump cassettecomprising a first pump chamber and a second pump chamber to deliver atarget volume of a medical fluid comprising a first fluid and a secondfluid, the method comprising: pumping, using the controller and thefluid control module, the first fluid in a first volume increment withthe first pump chamber; pumping, using the controller and the fluidcontrol module, the second fluid in the first volume increment with thesecond pump chamber; receiving data by the controller associated withthe first pump chamber and the second pump chamber to determine acumulative volume of the first fluid and a cumulative volume of thesecond fluid that have been pumped; suspending pumping of the firstfluid when the cumulative volume of the first fluid exceeds thecumulative volume of the second fluid by a predetermined fraction of thefirst volume increment; pumping, using the controller and the fluidcontrol module, the first volume increment of the second fluid with thesecond pump chamber; repeating the pumping of the first fluid and thesecond fluid in the first volume increment until a sum of the cumulativevolume of the first fluid and the cumulative volume of the second fluidthat has been delivered reach a predetermined amount that is less thanthe target volume; determining with the controller which of the firstand second pump chambers is the pump chamber that pumped a smallercumulative volume of fluid; operating, using the controller and thefluid control module, the pump chamber that pumped the smallercumulative volume of fluid to pump in a second volume increment that isless than the first volume increment; and repeating pumping of thesecond volume increment with the pump chamber that pumped the smallercumulative volume of fluid until the target volume of the medical fluidhas been delivered.
 2. The method according to claim 1, wherein thepredetermined amount equals the target volume minus a finish volume. 3.The method according to claim 2, wherein the second volume increment isless than the finish volume.
 4. The method according to claim 2, whereinthe second volume increment is ⅓ of the finish volume.
 5. The methodaccording to claim 1, wherein the data received in the receiving step bythe controller associated with the first pump chamber and the secondpump chamber to determine a cumulative volume of the first fluid and acumulative volume of the second fluid that have been pumped comprisespressure data associated with the first pump chamber and the second pumpchamber.
 6. The method according to claim 1, further comprising an actof monitoring pumping of first volume increment and the second volumeincrement and adjusting a pump stroke volume of at least one of thefirst and second pumping chambers.
 7. The method according to claim 1,further comprising an act of: determining with the controller acumulative amount of the second volume increments pumped during therepeating pumping of the second volume increment act, and determiningwith the controller when the target volume of the medical fluid has beendelivered.
 8. The method according to claim 1, wherein the secondincremental volume is less than a full volume of the first and secondpump chambers.
 9. The method according to claim 1, wherein the secondvolume increment is 3 ml or less.
 10. A method for operating a fluidcontrol module of a pumping system using a controller to operate a pumpcassette configured to deliver a target volume of a first fluid and asecond fluid, the cassette comprising a first pump chamber and a secondpump chamber, the first pump chamber and the second pump chamber eachactuated by a flexible membrane, the method comprising: actuating withthe controller the membrane of the first pump chamber to pump the firstfluid in a first volume increment; actuating with the controller themembrane of the second pump chamber to pump the second fluid in thefirst volume increment; receiving data by the controller associated withthe first pump chamber and the second pump chamber to determine acumulative volume of the first fluid and a cumulative volume of thesecond fluid that have been pumped; suspending pumping of the firstfluid when the cumulative volume of the first fluid exceeds thecumulative volume of the second fluid by a predetermined fraction of thefirst volume increment; actuating with the controller the membrane ofthe second pump chamber to pump the first volume increment of the secondfluid; repeating the actuation of the membrane of the first pump chamberto pump the first fluid in the first volume increment and actuation ofthe membrane of the second pump chamber to pump the second fluid in thefirst volume increment until a sum of the cumulative volume of the firstfluid and the cumulative volume of the second fluid that has beendelivered reach a predetermined amount that is less than the targetvolume; determining with the controller which of the first and secondpump chambers is the pump chamber that pumped a smaller cumulativevolume of fluid; actuating with the controller the membrane of the pumpchamber that pumped the smaller cumulative volume of fluid to pump fluidin a second volume increment that is less than the first volumeincrement; and repeating actuation of the membrane of whichever of thefirst pump chamber or the second pump chamber was determined in thedetermining step to have pumped the smaller cumulative volume of fluidto pump the second volume increment until the target volume of the firstfluid and the second fluid has been delivered.